Pharm Exam II ?s

A patient has been taking docusate sodium (Colace) daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? A "My doctor says that I've developed colon polyps." B "I only have a bowel movement when I take the medicine." C "The dental hygienist said I was losing the enamel on my teeth." D "I've noticed that I'm having tremors now in my left hand."

"I only have a bowel movement when I take the medicine." Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.

Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times? A. Whenever needed (PRN) as a quick-relief agent B. Twice daily combined with an inhaled glucocorticoid C. Only with a long-acting beta2 agonist (LABA) D. If nighttime awakenings occur more than 2 days a week

A

Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered? A. "Gargle after using your inhaler." B. "Take the medication immediately at the onset of an attack." C. "Take your albuterol first, followed by the Flovent 5 minutes later." D. "Make sure you monitor your fingerstick blood glucose level each morning."

A

Which medication is indicated for suppression of cough? A. Benzonatate (Tessalon) B. Guaifenesin (Mucinex) C. Acetylcysteine (Mucomyst) D. Fluticasone furoate (Flonase)

A. Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant. Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.

The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A. Age B. Developmental stage C. Body weight D. Swallowing ability

A. Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.

A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Pseudoephedrine (Sudafed) B. Montelukast (Singulair) C. Mometasone (Nasonex spray) D. Oxymetazoline (Afrin spray)

A. Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.

The nurse is caring for a patient receiving atropine (Sal-Tropine). Which is a therapeutic indication for giving this drug? Use as a preanesthesia medication Treatment of tachycardias Prevention of urinary retention Reduction of intraocular pressure in glaucoma

A. Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It often is administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.

The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent? A. Neostigmine (Prostigmin) B. Atropine (Sal-Tropine) C. Pralidoxime (DuoDote) D. Dobutamine (Dobutrex)

A. Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used.

A nurse is preparing to give bethanechol (Urecholine). What is an expected outcome of this drug? A. Nondistended bladder B. Increased heart rate and blood pressure C. Improved pulse oximetry reading D. Relief of cardiac rhythm problems

A. Bethanechol is a muscarinic agonist and therefore activates muscarinic receptors. This can lead to relaxation of the urinary sphincter muscles and increased voiding pressure. It also can cause bradycardia and hypotension, bronchoconstriction, and dysrhythmias in hyperthyroid patients.

A patient is receiving morphine sulfate and promethazine (Phenergan). It is most important for the nurse to assess what? A. Heart rate B. Alertness C. Blood pressure D. Bowel sounds

Alertness (both are CNS depressants)

A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium (Metamucil) for 2 weeks. Which is the nurse's priority action? A Consult the physician about another laxative choice. B Check the dose, because an increase may be indicated. C Ask whether the patient is toileting at the same time every day. D Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.

Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium. Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.

A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? A. "I'll take a dose as soon as I feel short of breath and start to cough." B. "While taking this medicine, I may be able to reduce my steroid medication." C. "This is the priority medication for preventing exercise-induced asthma symptoms." D. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."

B

A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium [Spiriva]. Which behavior by the patient would indicate that the teaching has been effective? A. Combines tiotropium with an antacid B. Sucks on hard candy as needed C. Prevents constipation with a stool softener D. Wears long sleeves and a wide-brim hat

B

To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? A. Only in an emergency B. On a continuing, daily basis C. To abort an asthma attack D. 2 weeks on, 2 weeks off

B

Which statement should the nurse include in the teaching for a patient who is to be started on zileuton [Zyflo]? A. "Use your zileuton [Zyflo] inhaler every 12 hours." B. "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." C. "Take the zileuton [Zyflo] 2 hours before eating breakfast each day." D. "Take an extra dose of zileuton [Zyflo] if you have an asthmatic attack."

B

A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion

B. Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.

Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A. "I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad."

B. Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.

Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A. "Clean the nasal applicator after use to prevent contamination." B. "Take the medication daily throughout the allergy season." C. "Expect a decrease in your nasal congestion in a day or two." D. "Take a stool softener daily to avoid the side effect of constipation."

B. For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.

Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion

B. Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.

A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A. Efficacy is seen within the first 24 hours of signs and symptoms. B. Evidence has been inconclusive, and more research is needed. C. Lozenges with the lemon-lime formula are the most effective. D. Recovery is accelerated, and symptoms resolve quickly.

B. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.

A patient goes to the emergency department after using organophosphate insecticides improperly. What assessment finding would the nurse expect? A. Urinary retention B. Stool incontinence C. Mydriasis D. Flushed, dry skin

B. A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis.

The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A 60-year-old woman with an overactive bladder (OAB) A 72-year-old man with glaucoma A 45-year-old woman with peptic ulcer disease (PUD) A 26-year-old man being prepared for surgery today

B. Anticholinergic drugs tend to cause adverse effects of dry mouth, blurred vision, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, and asthma. They are contraindicated in patients with glaucoma because of the potential danger of increased intraocular pressure. Anticholinergics are used to treat OAB and are used as preanesthetic agents. They are not contraindicated in PUD.

Which label most aptly describes the drug atropine (Sal-Tropine)? A. Cholinergic B. Parasympatholytic C. Muscarinic agonist D. Parasympathomimetic

B. Atropine is a muscarinic antagonist agent. Other terms for this agent are parasympatholytic, antimuscarinic, muscarinic blocker, and anticholinergic.

The nurse is preparing to give neostigmine (Prostigmin). What best describes the action of this drug? A. It inhibits acetylcholine at all cholinergic synapses. B. It prevents inactivation of acetylcholine. C. It prevents activation of muscarinic receptors. D. It stimulates activation of adrenergic receptors.

B. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions.

The nurse identifies which symptom as a result of activation of histamine1 (H1) by allergic reaction? A. Hypertension B. Bronchoconstriction C. Sweating D. Pupillary dilation

Bronchoconstriction

A patient who takes cromolyn for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness? A. It should be used infrequently because of systemic adverse effects. B. One 10-mg tablet should be taken at least 2 hours before exercising. C. It should be administered by inhalation 15 minutes before anticipated exertion. D. It should be used as a quick-relief agent if exercise triggers asthma symptoms.

C

A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? a. "After you inhale the medication once, repeat until you obtain symptomatic relief." b. "Wait no longer than 30 seconds after the first puff before taking the second one." c. "Use a spacer with the inhaler and rinse your mouth after each dose administration." d. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."

C

Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? A. Increases the daily intake of vitamin D and calcium B. Records daily peak expiratory flow rates C. Supplements additional doses at times of stress Correct D. Uses alternate-day therapy to reduce adverse effects

C

Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough

C. Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.

Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A. "It is only moderately effective." B. "There are few adverse reactions." C. "Relief may take a week or two." D. "It suppresses histamine release."

C. Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.

A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A. Chlorpheniramine (Chlor-Trimeton) B. Cetirizine (Zyrtec) C. Ephedrine D. Ipratropium bromide (Atrovent)

C. Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.

A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A. "Restrict cold fluids to promote reduced mucus production." B. "Take the medication once a day only, usually at bedtime." C. "Increase your fluid intake to reduce the viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."

C. Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.

Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A. Dry mouth and constipation B. Drowsiness and sedation C. Congestion and stuffiness D. Itching and skin rash

C. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.

Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine (Astelin)? A. "Take the pill in the morning before breakfast." B. "Headache may be a side effect of the medication." C. "You may experience an unpleasant taste in your mouth when using azelastine." D. "You will experience a decrease in nasal congestion if the medication is working."

C. With both formulations of azelastine (Astelin and Astepro), patients often complain of an unpleasant taste. Azelastine is administered as an intranasal metered spray. Headache is a side effect of the intranasal antihistamine olopatadine. Antihistamines do not reduce nasal congestion.

The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin (Ditropan) for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan? A. "You may experience a slower heart rate. Call your doctor if it is below 60." B. "Ditropan is very effective. Most patients experience significant relief." C. "Sip on water and hard candy to help with the problem of dry mouth." "D. Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan."

C. Oxybutynin is an anticholinergic drug that commonly causes dry mouth. Other side effects include constipation, tachycardia, urinary hesitancy, urinary retention, and visual disturbances. Oxybutynin is only moderately effective (30% better than placebo). It should not be taken with other drugs with anticholinergic properties, such as antihistamines, because of the additive anticholinergic effects.

The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine (Prostigmin), 75 mg PO twice daily. What is the most important initial nursing action? A. Obtain a measurement of the plasma level of neostigmine B. Teach the patient to wear a Medic Alert bracelet C. Assess the patient's ability to swallow D. Check the patient's deep tendon reflexes (DTRs)

C. Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.

A patient with hepatic encephalopathy receives lactulose (Chronulac). The nurse expects which therapeutic outcome if the medication is having the desired effect? A Less ascitic fluid B Normal serum sodium level C Reduced ammonia level D Release of glycogen stores

C. Reduced ammonia level Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.

The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? A) Prepare to administer phentolamine (Regitine) B) Ensure that naloxone (Narcan) is available C) Institute the protocol for congestive heart failure (CHF) D) Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels

Correct: A

A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? A) Parasympathetic activity would increase. B) Parasympathetic signals would be depressed. C) Sympathetic activity would increase. D) Respiratory centers would be depressed.

Correct: A Acetylcholinesterase is an enzyme that metabolizes acetylcholine. When acetylcholine is not broken down, it continues to send its message. Acetylcholine is associated mostly with the parasympathetic nervous system; therefore, this system would be stimulated by acetylcholine-inhibiting drugs.

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A) Neutralized gastric acid B) Reduced stomach motility C) Increased barrier to pepsin D) Reduced duodenal pH

Correct: A Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate (Carafate). Reduced stomach motility is not an effect of milk of magnesia.

The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A) Cardiac rhythm B) Blood urea nitrogen C) Central nervous system (CNS) tremor D) Lung sounds

Correct: A Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias.

A nurse administers metoclopramide (Reglan) to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result? A) Blocking of serotonin and dopamine receptors B) Inactivation of histaminergic (H1) receptors C) Activation of chloride channels in the intestine D) Reduced motility in the small intestine

Correct: A Metoclopramide works by blocking serotonin and dopamine receptors in the chemoreceptor trigger zone (CTZ) and by increasing motility in the small intestine. This action minimizes gastric distention and the accompanying stimulation of the vomiting center. Metoclopramide does not block H1 receptors or activate chloride channels in the intestine.

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A) Omeprazole (Prilosec) B) Famotidine (Pepcid) C) Misoprostol (Cytotec) D) Ranitidine (Zantac)

Correct: A Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow

A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent? A) Loperamide (Imodium) B) Alosetron (Lotronex) C) Bismuth subsalicylate (Pepto-Bismol) D) Paregoric (camphorated opium tincture)

Correct: A Opioids are the most effective antidiarrheal agents that activate opioid receptors in the gastrointestinal tract, thus slowing intestinal transit. This action allows more time for fluid and electrolyte absorption in the colon. Loperamide, a structural analog of meperidine, is used to reduce the volume of discharge from ileostomies. Alosetron is a dangerous medication that is approved only for irritable bowel syndrome-diarrhea (IBS-D). Paregoric is not appropriate as an antidiarrheal for longer term use, because it has moderate potential for abuse. Bismuth subsalicylate is effective only for mild diarrhea.

A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine (Zantac) and bismuth subsalicylate (Pepto-Bismol). Which statement by the patient indicates that the teaching has been effective? A) "While I'm taking these medications, my bowel movements could look black." B) "I have a medicine at home to take when I start having some loose diarrhea stools." C) "I'm so glad that my allergies will be helped while I'm taking these medications." D) "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."

Correct: A Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin (Amoxil). Ranitidine (Zantac) produces selective blockade of H2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a PPI.

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process orchestrates this response? A) Stimulation of the sympathetic system B) Stimulation of the predominant tone of the organs C) Stimulation of the baroreceptor reflex D) Stimulation of the parasympathetic system

Correct: A Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure.

A nurse should associate which factors with the pathophysiology of peptic ulcer disease? (Select all that apply.) A) Poor submucosal gastric blood flow B) Presence of Zollinger-Ellison syndrome C) Reduced stomach production of bicarbonate D) Increased synthesis of prostaglandins E) Gastrointestinal (GI) tract colonized with Haemophilus influenzae

Correct: A, B, C Peptic ulcers develop when an imbalance exists between mucosal defensive factors and aggressive factors. Sufficient blood flow to cells of the GI mucosa is needed to maintain integrity. In Zollinger-Ellison syndrome, hypersecretion of acid alone causes ulcers by overcoming mucosal defenses. Bicarbonate is needed to neutralize hydrogen ions. Prostaglandins are needed to stimulate mucus and bicarbonate to maintain mucosal blood flow. Helicobacter pylori, not Haemophilus influenzae, is a bacillus that can disrupt the protective mucosal layer when colonized in the GI tract.

Which organs are controlled primarily by the parasympathetic system? (Select all that apply.) A) Gastrointestinal tract B) Respiratory tract C) Cardiovascular system D) Skin E) Salivary glands

Correct: A, B, D, E The sympathetic nervous system provides the dominant tone for the cardiovascular system.

What must be in place before alosetron (Lotronex) can be prescribed for a patient with IBS-D? (Select all that apply.) A) Intestinal obstruction has been ruled out. B) The patient is aware of the signs and symptoms of ischemic colitis. C) The physician is enrolled in a prescriber program for alosetron. D) The patient has signed a Patient-Physician Agreement. E) The patient's IBS-D has lasted at least 2 months and has not responded to conventional treatment.

Correct: A,B,C,D To ensure the best possible benefit/risk ratio, the manufacturer of alosetron and the FDA have established a risk management program that involves the active participation of the patient, prescriber, and pharmacist. The prescriber must be qualified to make an accurate diagnosis and to manage complications of therapy. Each patient must sign a Patient-Physician Agreement indicating that she or he understands the risks and benefits, agrees to treatment, will contact the prescriber if constipation or ischemic colitis develops, and will report to the prescriber if symptoms are not controlled after 4 weeks. Alosetron is contraindicated in patients with intestinal obstruction. The drug is approved for use in female patients only with severe IBS-D that has lasted for 6 months or longer and has not responded to conventional treatment.

Which receptors below are considered adrenergic receptors? (Select all that apply.) A) Alpha1 B) Beta2 C) Dopamine D) Muscarinic1 E) Beta1 F) Alpha2

Correct: A,B,C,E,F Alpha, beta, and dopamine receptors are all part of the sympathetic system and therefore are adrenergic receptors. Muscarinic receptors are part of the parasympathetic system and are cholinergic

Which medications are used in the treatment plan for chemotherapy-induced nausea and vomiting? (Select all that apply.) A) Lorazepam (Ativan) B) Meclizine (Antivert) C) Dolasetron (Anzemet) D) Loperamide (Imodium) E) Dexamethasone (Decadron)

Correct: A,C,E Lorazepam, a benzodiazepine, is used in combination regimens to suppress CINV. Dolasetron and dexamethasone also are used in the treatment of CINV. Meclizine is most often used to treat motion sickness, and loperamide is used to treat diarrhea.

A patient who has had a pancreatectomy is taking pancrelipase (Viokase). Which finding would the nurse use to evaluate the effectiveness of this drug? A) Increase in flatulence B) Reduction in fatty stools C) Resolution of jaundice D) Decrease in abdominal distention

Correct: B A deficiency of pancreatic enzymes through pancreatectomy or pancreatitis may compromise digestion, especially the digestion of fats. Fatty stools are characteristic of the deficiency. Replacement of pancreatic enzymes with pancrelipase results in a reduction of fat excretion through the stools. An increase in flatulence, resolution of jaundice, and a decrease in abdominal distention are not therapeutic effects of pancrelipase.

Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication? A) Tetracycline B) Metronidazole C) Bismuth subsalicylate D) Clarithromycin

Correct: B A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take the other medications, it does not create an adverse reaction.

A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what? A) Bicarbonate B) H. pylori C) Histamine2 D) Prostaglandins

Correct: B Antibacterial medications should be given to patients who have confirmed infection with H. pylori, a cause of ulcers. A breath test is a noninvasive means of measuring H. pylori levels. The patient is given radiolabeled urea, which converts to carbon dioxide and ammonia if H. pylori is present. Radiolabeled carbon dioxide then can be detected in the breath. Bicarbonate, histamine2, and prostaglandins are not affected by the actions of antibacterial medications for peptic ulcers.

Which statement made by the patient indicates the best understanding of teaching related to a new prescription for atenolol (Tenormin)? A) "I will increase my fluids to prevent constipation." B) "I will not stop taking this medication abruptly." C) "I will take the first dose of this medicine at night." D) "I will wear sunscreen and a hat when I work in the sun."

Correct: B Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. Patients should carry an adequate supply when traveling. It does not commonly cause constipation, first-dose hypotension, or photosensitivity.

The nurse is caring for a patient receiving propranolol (Inderal). Which finding is most indicative of an adverse effect of this drug? A) A heart rate of 100 beats per minute B) Wheezing C) A glucose level of 180 mg/dL D) Urinary urgency

Correct: B Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular (AV) heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system (CNS) effects.

A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? A) Amoxicillin (Amoxil) B) Cimetidine (Tagamet) C) Metronidazole (Flagyl) D) Omeprazole (Prilosec)

Correct: B Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

The nurse is reviewing the prescriber's orders and notes that omeprazole (Prilosec) has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? A) Aspirin 81 mg daily B) Clopidogrel (Plavix) 75 mg daily C) Heparin 5000 units subQ every 12 hours D) Metoprolol 50 mg every 8 hours

Correct: B For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.

A nurse should offer which fluid choice to a patient with acute diarrhea? A) Low-fat milk B) Apple juice C) Coffee with cream D) Prune juice

Correct: B Managing fluids and electrolytes is a high priority for patients with acute diarrhea because of the risk for dehydration. Clear liquids, such as apple juice, do not irritate the gastrointestinal (GI) tract. Milk products and other liquids, such as prune juice, which is not considered a clear liquid, could further irritate the GI tract.

Why does the nurse anticipate administering metoprolol (Lopressor) rather than propranolol (Inderal) for diabetic patients who need a beta-blocking agent? A) Metoprolol is less likely to cause diabetic nephropathy. B) Propranolol causes both beta1 and beta2 blockade. C) Metoprolol helps prevent retinopathy in individuals with diabetes. D) Propranolol is associated with a higher incidence of foot ulcers.

Correct: B Metoprolol is a second-generation beta blocker and as such is more selective. At therapeutic doses, it causes less bronchoconstriction and suppression of glycogenolysis, which can cause problems in diabetic patients. Propranolol blocks both beta1 and beta2 receptors.

Which statement made by the nurse is most important to include in the teaching plan for a patient being discharged from the hospital with a new prescription for prazosin (Minipress)? A) "You should increase your intake of fresh fruits and vegetables." B) "You should move slowly from a sitting to a standing position." C) "Be sure to wear a Medic Alert bracelet while taking this medication." D) "Take your first dose of this medication first thing in the morning."

Correct: B Orthostatic hypotension is the most serious potential complication of prazosin and other alpha1 blockers. Patients should be taught to change positions slowly to avoid dizziness and prevent falls. Fresh fruits and vegetables are good to include in the dietary teaching, but this is not as important as preventing hypotension. A Medic Alert bracelet should not be needed for this drug. This drug causes significant first-dose hypotension. First doses should be taken at bedtime. Patients should avoid hazardous activities for 12 to 24 hours after the first dose.

A patient going on a vacation cruise is prescribed a scopolamine transdermal patch (Transderm Scôp) for motion sickness. The nurse teaches the patient to recognize which side effect? A) Increased heart rate B) Dry mouth C) Irritability D) Urinary frequency

Correct: B Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance that is a common cause of motion sickness. The most common side effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less frequently. An increased heart rate and irritability are not associated effects.

A nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? A) Wheezing decreases due to bronchodilation. B) Heart rate decreases to 60 beats per minute. C) Diarrhea stool count decreases. D) Oxygenation improves because of bronchodilation.

Correct: B Stimulation of the parasympathetic nervous system (PNS) causes slowing of the heart rate. The PNS does not regulate temperature. The PNS would facilitate peristalsis and thus would not decrease diarrhea. The PNS is associated with contraction of bronchial smooth muscle.

Which approach should a nurse take to administer sucralfate (Carafate) to a patient with a duodenal ulcer? A) Crush the tablet into a fine powder before mixing it with water. B) Administer the tablet with sips of water 1 hour before meals. C) Allow the tablet to dissolve in water before administering it. D) Administer the tablet with an antacid for maximum benefit.

Correct: B Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form does not dissolve in water when crushed, and crushing it could reduce the effectiveness of the drug. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.

The nurse reviews the patient's medication record and notes the following: Sucralfate (Carafate) 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin (Dilantin) 200 mg orally daily at 8 AM. Which modifications, if any, should be made to the medication regimen? A) The medications can be administered as ordered. B) The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. C) The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. D) The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate (Carafate), because this is more time efficient.

Correct: B Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, all other options are incorrect.

The nurse is preparing to give terbutaline (Brethine) to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) A) Terbutaline must be given by a parenteral route. B) The selectivity of terbutaline is dose dependent. C) The patient may experience tremor with terbutaline. D) Terbutaline is a sympathomimetic drug. E) Bronchoconstriction is a potential adverse effect of terbutaline.

Correct: B,C,D Terbutaline is a noncatecholamine adrenergic agonist (sympathomimetic) drug. It can be given orally, because it is not a catecholamine. Tremor and tachycardia are potential adverse effects. It can be used to treat asthma and does not typically cause bronchoconstriction. When given at low therapeutic doses, it is selective for beta2 receptors.

Which instruction should the nurse give a patient who is to take bismuth subsalicylate for eradication of H. pylori? A) "Nausea and diarrhea are common side effects." B) "Do not drink alcohol while taking this medication." C) "The drug can cause your bowel movements to be black." D) "Take the medication through a straw to prevent staining of your teeth."

Correct: C Bismuth may impart a harmless black coloration to the tongue and the stool, and patients should be forewarned of this effect. Nausea and diarrhea are the most common side effects of clarithromycin (Biaxin), which also is used to treat H. pylori. Alcohol must be avoided when the patient is treated with metronidazole (Flagyl) for H. pylori infection, because it may cause a disulfiram-like reaction. Tetracycline, which is also highly active against H. pylori, can cause staining of developing teeth.

Which medication is useful for stimulating the appetite in patients with acquired immunodeficiency syndrome (AIDS)? A) Aprepitant (Amend) B) Ondansetron (Zofran) C) Dronabinol (Marinol) D) Metoclopramide (Reglan)

Correct: C Dronabinol is used to stimulate the appetite in patients with AIDS. It is administered before lunch and dinner. Aprepitant, ondansetron, and metoclopramide are used to prevent and treat emesis.

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A) +3 pitting edema B) Pain with urination C) New onset of disorientation to time and place D) Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm

Correct: C Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.

A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy? A) Brain B) Breast C) Leukemia D) Lung

Correct: C In the treatment of oral mucositis, palifermin acts through keratinocyte growth factor (KGF) receptors to stimulate the proliferation and migration of epithelial cells. Because these receptors are not found on cells of hematopoietic origin, palifermin is used only in hematologic malignancies. Palifermin is not indicated for oral mucositis treatment in patients with solid tumors of the brain or breast or for lung cancer.

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A) Ask the healthcare provider for a reduction in dose. B) Encourage the patient to increase dietary fiber. C) Administer the drug with an aluminum hydroxide antacid. D) Instruct the patient to keep an accurate stool count.

Correct: C Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

A nurse should take which action when administering an intravenous piggyback (IVPB) of pantoprazole (Protonix) 40 mg? A) Administer the infusion at least 1 hour before a meal B) Avoid giving the infusion within 30 minutes of an antibacterial agent C) Prevent precipitates by using an in-line filter D) After reconstitution of the drug, administer the infusion over 5 minutes

Correct: C Pantoprazole is a PPI given to treat peptic ulcer disease. For IV therapy, an in-line filter must be used to remove any precipitate. The infusion may be given without regard to food. IVPB infusions are done over 15 minutes. Giving an antibacterial agent is unrelated to IV administration.

The nurse is caring for several patients. For which patient is propranolol (Inderal) most likely to be contraindicated? A) A 30-year-old woman with cardiac dysrhythmias B) A 48-year-old man with hypertension C) A 60-year-old woman with diabetes D) A 72-year-old man with angina

Correct: C Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in diabetic patients. It is safe to use propranolol in dysrhythmias, hypertension, and angina.

A nurse should give which nonmedication instruction to a patient who has peptic ulcers? A) "Reduce your intake of caffeine-containing beverages, such as coffee and colas." B) "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." C) "It would be better to eat five or six small meals a day instead of three larger ones." D) "An ulcer diet of bland foods with milk and cream products will speed healing."

Correct: C Some optimal nondrug measures, in addition to drug management, to aid patients with peptic ulcers include changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.

A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine (Azulfidine). Which statement by the patient would indicate understanding of the information? A) "My tongue may become discolored and my taste altered." B) "I may have constipation, so I'll increase my fluid intake." C) "I'll report any fatigue or sore throat and fever to my doctor." D) "I'll immediately report any chest pain or shortness of breath."

Correct: C Sulfasalazine is used to treat ulcerative colitis by suppressing inflammation. It has the adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic anemia. Patients should report any signs of infection and/or fatigue. Altered taste, tongue discoloration, constipation, chest pain, and shortness of breath are not effects associated with sulfasalazine.

The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A) Topical phenylephrine B) Subcutaneous terbutaline C) Intravenous epinephrine D) Inhaled albuterol

Correct: C When beta1 receptors are activated, cardiac contraction is stimulated. When a beta1 agonist is indicated, epinephrine (given IV) is the preferred drug. Beta1 agonist drugs (e.g., epinephrine), which are kept on the emergency cart, may be injected directly into the heart during an arrest. Alpha1 activation causes hemostasis, nasal decongestion, vasoconstriction, and mydriasis. Alpha2 activation reduces sympathetic outflow to the heart and blood vessels and relieves severe pain. Beta2 activation causes bronchodilation and relaxation of uterine smooth muscle. Topical phenylephrine is helpful for nasal congestion. Terbutaline is indicated for preterm labor and/or asthma. Albuterol is indicated for asthma.

The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) A) Check the blood urea nitrogen (BUN) and creatinine levels B) Obtain insulin from the medication cart C) Assess the patency of the IV line D) Review the allergy history E) Assess the vital signs

Correct: C,D,E All of the actions mentioned might be appropriate for this patient. However, because epinephrine can cause necrosis with extravasation, the first priority is to assess the patency of the IV line before beginning administration. Reviewing the patient's allergy history is essential, as is assessing the vital signs, particularly the heart rate and blood pressure. Epinephrine is a vasoconstrictor and can cause a dramatic increase in the heart rate and blood pressure.

A nurse is preparing to give a medication that stimulates the beta2 receptors. What response will the nurse expect from this drug? A) Increased peristalsis B) Constriction of the pupil C) Hypoglycemia D) Bronchodilation

Correct: D Activation of beta2 receptors leads to bronchodilation; decreased uterine contractions; hyperglycemia; and vasodilation of the heart, lungs, and skeletal muscle. It does not produce increased peristalsis, constriction of the pupil, or hypoglycemia.

A nurse should teach a patient who takes alosetron (Lotronex) for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition? A) Blurred vision B) Heart palpitations C) Bruising D) Constipation

Correct: D Alosetron selectively blocks serotonin receptors on neurons that innervate the viscera, thereby reducing the symptoms associated with IBS-D. Serious complications of constipation and ischemic colitis can be life-threatening. According to the risk management program established by the manufacturer and the U.S. Food and Drug Administration (FDA), treatment with alosetron should be stopped immediately if either of these conditions develops. Blurred vision, heart palpitations, and bruising are not adverse effects of alosetron.

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin (Amoxil). Which of these should the nurse establish as a therapeutic outcome? A) Inhibition of an enzyme to block acid secretion B) Coating of the ulcer crater as a barrier to acid C) Selective blockade of parietal cell histamine2 receptors D) Disruption of the bacterial cell wall, causing lysis and death

Correct: D Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate (Carafate). Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.

The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system? A) Norepinephrine B) Epinephrine C) Dopamine D) Acetylcholine

Correct: D Norepinephrine, epinephrine, dopamine, and acetylcholine all are neurotransmitters for the peripheral nervous system, but acetylcholine is the most abundant. It is released by all preganglionic neurons in both the sympathetic and parasympathetic systems. It also is released by all postganglionic neurons of the parasympathetic nervous system.

A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective? A) Scopolamine (Transderm Scôp) and lorazepam (Ativan) B) Prochlorperazine (Compazine) and diphenhydramine (Benadryl) C) Ondansetron (Zofran) and dimenhydrinate (Dramamine) D) Aprepitant (Emend) and ondansetron (Zofran)

Correct: D Regimens for preventing CINV may include medications such as a serotonin receptor antagonist (ondansetron); the substance P/neurokinin1 antagonist aprepitant; and a benzodiazepine (lorazepam). Scopolamine and dimenhydrinate are indicated for motion sickness, not CINV; diphenhydramine is an antihistamine indicated for allergic reactions.

The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? A) "I will keep my medication in the refrigerator when I'm not using it." B) "I should take this medication within 30 minutes of the onset of symptoms." C) "I must remove my pants before injecting the medication into the leg." D) "I will jab this medication firmly into my outer thigh if needed."

Correct: D The EpiPen should be stored in a cool, dark place, but refrigeration can damage the injection mechanism. The medication should be taken at the first sign of symptoms. Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the patient should form a fist around the unit with the black tip pointing down, remove the activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the unit, and massage the area for 10 seconds. The medication can be given directly through clothing if necessary.

An adult patient in a physician's office reports severe diarrhea after returning from a trip to Mexico. Which medication might be prescribed for this patient? A) Ciprofloxacin (Cipro) 500 mg twice daily B) Sulfasalazine (Azulfidine) 500 mg daily C) Metoclopramide (Reglan) 10 mg three times daily 30 minutes before meals and at bedtime D) Ondansetron (Zofran) 8 mg three times daily

Correct:A Traveler's diarrhea, when severe, can be treated with ciprofloxacin, levofloxacin, or norfloxacin. Sulfasalazine is indicated for the treatment of mild to moderate ulcerative colitis; it is not used for the treatment of infection. Oral metoclopramide, a prokinetic agent, is administered for the treatment of diabetic gastroparesis and suppression of gastroesophageal reflux. Ondansetron is used for the treatment of emesis related to chemotherapy, radiation, and anesthetic agents.

Why is intramuscular (IM) administration of promethazine (Phenergan) preferred over intravenous (IV) administration? A) The risk of respiratory depression is eliminated with IM injection. B) Extravasation of IV promethazine can lead to abscess formation or tissue necrosis. C) Extrapyramidal reactions do not occur when the drug is administered IM. D) IM injection has a more rapid onset of action.

Correct:B Extravasation of IV promethazine can lead to abscess formation, tissue necrosis, and gangrene, leading to amputation; therefore, IV administration should be avoided. If it must be done, promethazine should be given through a large-bore IV line. Respiratory depression and extrapyramidal side effects can occur regardless of the route of administration. Drugs administered IM have a longer onset of action than those given IV.

A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? A. Oral theophylline [Elixophyllin] B. Subcutaneous omalizumab [Xolair] C. Inhaled mometasone furoate [Asmanex] D. High-dose albuterol [Proventil] via nebulizer treatment

D

A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? A. Echinacea B. Cimetidine [Tagamet] C. Sunscreen products D. Caffeine

D

Which symptom is the most indicative of muscarinic poisoning? A. Constipation B. Heart rate of 140 beats per minute C. Blood pressure of 180/110 mm Hg D. Blurred vision

D. Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension.

Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids

D. Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.

A nurse prepares to administer a new prescription for bethanechol (Urecholine). Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? A. Constipation B. Hypertension C. Psoriasis D. Asthma

D. Muscarinic agonists induce bronchospasm, which would cause problems for a patient with a history of asthma.

What best describes the rationale for using neostigmine (Prostigmin) in the treatment of myasthenia gravis? A. It promotes neuromuscular blockade in the periphery. B. It promotes emptying of the bladder and sphincter relaxation. C. It reduces intraocular pressure and protects the optic nerve. D. It increases the force of skeletal muscle contraction.

D. Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness.

Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A. Epilepsy B. Diabetic coma C. Meningitis D. Psychosis

D. Antimuscarinic poisoning often resembles psychosis and psychotic episodes. It is important to differentiate, because antipsychotic drugs have antimuscarinic properties and could intensify the symptoms of poisoning.

A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement when? A. In 15 minutes to 1 hour B. In 2 to 4 hours C. In 1 to 3 days D. In 6 to 12 hours

D. In 6 to 12 hours Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.

A patient is taking a first-generation H1 blocker for the treatment of allergic rhinitis. It is most important for the nurse to assess for which adverse effect? A. Skin flushing B. Wheezing C. Insomnia D. Dry mouth

Dry mouth

A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) Sedation Irritability Paranoia Anxiety Weight loss

Irritability & Anxiety. Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.

A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl (Dulcolax). When does the nurse administer the medication? A Just before bedtime B Before the morning bath C At the evening meal D After ambulating

Just before bedtime Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night.

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative? A Mineral oil B Polyethylene glycol-electrolyte solution (GoLYTELY) C Magnesium salts (magnesium citrate) D Docusate sodium (Colace)

Polyethylene glycol-electrolyte solution (GoLYTELY) GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids, so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.

A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what? A. Tinnitus B. Seizure activity C. Lethargy D. Visual disturbances

Seizure activity

A patient asks a nurse, "Why should I switch to fexofenadine (Allegra) for my allergies when I've taken diphenhydramine (Benadryl) for so long?" Which response should the nurse make? A. "You'll have much less risk of cardiac problems." B. "There is not nearly as much drowsiness and sedation." C. "The biggest benefit is that the cost is so much lower." D. "The dosing is more convenient, because you take it once a week."

There is not nearly as much drowsiness and sedation

A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication? a. Bethanechol b. Droperidol c. Promethazine d. Ondansetron

a. Bethanechol Bethanechol is a muscarinic agonist that is used to treat abdominal distention and urinary retention. The other three agents are antiemetics and would not be useful in this situation.

A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent: a. anxiety. b. bradycardia. c. dry mouth. d. hypertension.

b. bradycardia. Atropine, an anticholinergic drug, is used as an adjunct to anesthesia to counter the effects of vagal stimulation, which is caused by surgical manipulations that trigger parasympathetic reflexes, resulting in bradycardia. Atropine is not an anxiolytic. Atropine causes dry mouth and sometimes is used to minimize bronchial secretions

A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will: a. assess for excessive bronchial secretions. b. expect a reduction in the patient's anxiety. c. monitor the patient's heart rate. d. observe for muscle paralysis.

c. monitor the patient's heart rate. Anticholinergic drugs, such as atropine (Sal-Tropine), may be given to reduce the risk of bradycardia during surgery. Atropine can alter bronchial secretions, but the effect would be to reduce them, not increase them. It is not used to reduce anxiety. It does not cause muscle paralysis.

A patient has had an overdose of an intravenous cholinergic drug. The nurse should expect to administer which drug as an antidote? a. atenolol b. bethanechol c. dobutamine d. atropine sulfate

d. atropine sulfate

A patient is brought to the emergency department with a severe case of atropine overdose. Which drug will the nurse expect to administer? Choose one answer. a. atenolol b. bethanechol c. scopolamine d. physostigmine

d. physostigmine

A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer? A. Promethazine [Phenergan] B. Epinephrine C. Diphenhydramine [Benadryl] D. Hydroxyzine [Vistaril]

skip the antihistimine and run straight for Epinephrine (Adrenalin)